Social and Policy Perspective on Tobacco Use

Transcription

1 Social and Policy Perspective on Tobacco Use Kenneth E. Warner University of Michigan School of Public Health National Cancer Policy Forum Workshop on Reducing Tobacco-Related Cancer Incidence and Mortality Institute of Medicine June 11, 2012

2 Coverage 1. A (brief) consideration of social change re smoking 2. Policy interventions & their effects 3. Why evidence-based policies a. Are essential b. Will not be enough

3 Social change 180 change in attitudes and norms

4 Then Now

5 Cultural position of smoking has Then changed dramatically Now

6 What has produced this major behavioral & cultural change? 1. Science new knowledge 2. Effective transmission to public 3. Origins of social/norm changes & behavior change n First among high education pop 4. Then virtuous cycle : n n n Policy Begets more norm & behavior change Begets more policy (etc.)

7 Adult per capita cigarette consumption, U.S., End of WW II 1 st Surgeon General s Report Broadcast Ad Ban Non-Smokers Rights Movement Begins 1 st Smoking-Cancer Concern Fairness Doctrine Messages on TV and Radio Master Settlement Agreement Great Depression Federal Cigarette Tax Doubles Surgeon General s Report on ETS Fed. Cig. Tax Increase

8 Actual adult per capita cigarette consumption and predicted in absence of antismoking campaign, U.S., consumption Actual Predicted Actual Predicted year

9 Health consequence Since 1964, > 5 million premature deaths averted in U.S. as a result of campaign- induced decisions to quit smoking or not to start. On average, year gain! n Greatest public health success story of last 50 years n Greatest remaining burden of preventable death and illness

10 Types of policy interventions n Information & education n Reports of the Surgeon General; warning labels; school health education; media anti-smoking campaigns n Incentives n Tax increase n Laws & regulations n Ad ban; smoke-free workplace laws; sales to minors & PUP laws

11 Intervention effectiveness Effective 1. Info & education 2. Tax 3. Clean indoor air laws, policies 4. Counter-advertising 5. Ad bans 6. Comprehensive TC programs Not effective 1. School health ed 2. Warning labels (New ones?) 3. Insurance differentials 4. Minors possession, use, & purchase laws 5. Sales to minors laws

12 Early years of anti- smoking campaign n Information & public education n 1964 Surgeon General s s report & media coverage n 15% decline in cig sales first 3 months n Fairness Doctrine ads n Tax increases,

13 Cigarettes per capita Re al cig are tte price s & pe r capita cons um ption, US, Price (1982/84 cents) Year consumption price

14 Effects of tax/price increase n Price elasticity of demand = -0.3 to -0.5 (10% price increase 3-5% demand decrease) n Half prevalence, half cigs/day n Low-income smokers more price responsive than high-income income smokers (implications for health disparities) n Children times more price responsive than adults

15 Effects of smoke-free air laws ( 30 states and 30 countries) n Reduce worker exposure (80-95%) n Increase quitting (3%) n Decrease daily consumption n Decrease employer costs n Decrease AMIs

16 Advertising & counter-ads n Restrictions on advertising & promotion n Counter-advertising

17 What doesn t t work (well and now)? n School health ed (as administered) n Sales-to to-minors and PUP laws

18 What may or may not work? n Warning labels n Current ones don t t work n New ones?

19 Aggregate impacts of TC in US n Dramatic but over time n But the problem isn t t solved

20 Persistence of smoking n 20% remain smokers n 70% want to quit n 50% try each year n 2.5% (or fewer) succeed

21 The big problem re smoking: Remaining smokers different n Heavily addicted (Hard core?) n Low SES n < 10% college grads smoke n Some blue collar pops. > 30% n ½ have mental illness or substance abuse co-morbidity n Self medicating? n Some may not want to quit

22 Where is smoking headed? n Concern re adult prevalence being flat (but dropped 2010) n Concern re slowness of decline

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26 Where do we go from here? Likely near-future directions n More states go smoke-free n Within 5 years, nearly all states will be smoke-free n Cigarette excise tax increases states (and perhaps federal several years hence) n U.S. smoking prevalence to % 17% by 2020 (19.3% in 2010)

27 Policy innovations n Novel outdoor smoking restrictions n Public parks and beaches (NYC) n Entire university campuses (Univ. of Michigan) n Cars with kids inside

28 Policy innovations (cont d.) n Product regulation (with new FDA authority) n Plain packaging n Restrictions on marketing of some new products; approval of novel treatments n Approval of a true nicotine inhaler?? (E- cig?)

29 Policy innovations (cont d.) n End game policies n Govt. control of supply/sales n Sinking lid on availability n Prohibiting possession of tobacco for people born after (e.g.) 2000 n Licensing smokers n Reducing nicotine to non-addicting levels n Eventual prohibition, or prohibition lite (banning combusted tobacco products)

30 Tobacco control is health policy and cancer control n 6-10% of U.S. health care costs n Greatest behavioral determinant of morbidity and mortality n Greatest behavioral determinant of health disparities n Leading cause of cancer death in men and women and most avoidable

31 Thank you